Apply Online

MYERS PROPERTIES
6554 Center St.
DES MOINES, IOWA 50312
515-277-8761

RENTAL APPLICATION*

*A $10 application fee must be received by Myers Properties at the address above before this application will be processed.
Please use the tab key to move from entry field to entry field

Unit requesting   

Date of Application :

-- mm/dd/yy

Personal Information
Name
Phone
Cell Phone
Alias and/or
maiden name
Social Security No.
Driver's License
State & No.
Date of Birth
Current Address
Address (cont.)
City
State/Province
Zip/Postal Code
Present Landlord
Telephone #
Current Rent 
How long have you lived there?
Reason for Leaving? 
Prior Address
Address (cont.)
City
State/Province
Zip/Postal Code
Prior Landlord
Telephone #
How long did you live there?
Reason for Leaving? 
How many in your family? , #Adults , #Children
Children's names and ages 
Employment Information
Employer 
Position 
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Supervisor 
Supervisor Telephone #
How long
If less than 6 month, 
name previous employment
Previous Supervisor 
Previous Supervisor 
Telephone #
Salary Per Month
Additional sources of income

CO-APPLICANT INFORMATION
Co-Applicant 
Personal Information
Name
Date of Birth
Social Security No.
Driver's License
State & No.
Alias and/or
maiden name
Phone
Current Address
Address (cont.)
City
State/Province
Zip/Postal Code
Current Landlord
Telephone #
Current Rent 
Reason for Leaving? 
Prior Address
Address (cont.)
City
State/Province
Zip/Postal Code
Prior Landlord
Telephone #
Co-Applicant 
Employment Information
Employer 
Position 
Supervisor
Supervisor Telephone #
Salary Per Month
Additional sources of income

BANK INFORMATION

Bank Name
Bank Telephone #
Street Address
City, State, Zip
Checking Account #
Savings Account #
PERSONAL REFERENCES
Parents Name
Address
City, State, Zip
Telephone #
Nearest Relative
Address
City, State, Zip
Telephone #
Non-Relative
Address
City, State, Zip
Telephone #
ADDITIONAL INFORMATION
Number of Vehicles
Make/Model Year Color Tag #
1.
2.
3.

 
Have you ever filed for bankruptcy? Yes No If yes, when?
Have you ever been served an eviction notice or been asked to vacate a property you were renting? Yes No If yes, explain
Have you ever willfully or intentionally refused to pay rent when due? Yes No If yes, explain
Have you ever been arrested? Yes No If yes, what were the charges?
Were  you convicted? Yes No  
Have you ever changed your name? Yes No If so, list all previous names
Do you have a pet? Yes No What kind?
How many?
E-mail address
Telephone

By submitting this online form, I declare the above information is true and correct. I understand that Myers Properties and an outside agency will obtain complete criminal and credit reports for purposes of tenant screening and verification of information. I also authorize Myers Properties to make further credit inquiries in regard to continued creditworthiness and collection of unpaid rent or damages to the premises.